1. Cancer Right Care Optimisation Workshop Supplementary data analysis 3rd November 2015

2. Supplementary analysis
Follow on analysis from deep dive
Adjust for demand (incidence)
Understand local recording variations/ practices
Identify where the opportunity exists
Focus on initial areas identified i.e. skin, haematolgoical and urology.

3. Cancer incidence CCG has high incidence in cancer overall
2013 cancer incidence from cancer commissioning toolkit – 25 CCGs
CCG has high incidence in cancer overall
CCG highest incidence in skin, haematological and gynae cancers in cluster group
Opportunity is in reducing demand – public health etc.

4. Cancer incidence v spend
There is a clear correlation between high secondary spend and high incidence of cancer
However, not all variances can be explained by high incidence.

5. Cancer growth rates
National 2WW
National
62-day
Incidence Cases
Incidence Rate
2011/12
1,095,916
111,053
274,233
594
2012/13
1,206,588
115,817
281,335
599
2013/14
1,348,947
123,087
291,847
611
Annual change
126,516
6,017
8,807 8
% change
11.54%
5.42%
3.21%
1.42%
Nationally the incidence of cancer has grown by 1.4 percent but the number of urgent GP referrals is up 11.5 percent.

6. Skin cancer
When adjusted for incidence the national top quintile gain reduced from 2585 day-case admissions to 1564
1021 extra day-case admissions are attributable to demand and could be addressed through prevention
1564 remaining day-case admissions is the level of hospital activity above expected level for our population
Additionally CCG received rebate of £366k for JC15z in 2014/15 as a result of day-case to outpatient procedures.

7. Skin cancer Elective inpatients
Elective admission opportunity has reduced significant once adjusted for incidence
Elective inpatient opportunity further reduced once recent trends included
Current activity is forecast to be at top quintile in 2015/16.

8. Urological cancer
When adjusted for incidence the gain to reach national top quintile reduced from 531 day-case admissions to 439.

9. Urological cancer
Activity
Inpatients
2013/14
2014/15
2015/16 (FOT)
% change
Inpatient
Plymouth Hospitals NHS Trust
239
265
235
-1.59%
Royal Devon & Exeter
445
492
487
9.48%
Northern Devon NHS Trust
113
105
132
16.81%
Daycase
226
295
350
55.04%
996
888
679
-31.81%
269
276
240
-10.78%
Outpatients
2964
3016
3420
15.38%
2433
2890
3497
43.72%
1596
1654
1711
7.22%
Outpatient to daycase ratio
13.12
10.22
9.76
2.44
3.25
5.15
5.93
5.99
7.13
There has been a reduction in day-case admissions of 221 from 2013/14 to 2015/16 (FOT) which has halved the potential gain
Remaining gain could be achieved if NDHT and RD&E had the same outpatient to day-case ratio as PHNT.

10. Haematological cancer
When adjusted for incidence the gain to reach national top quintile reduced from 2141 day-case admissions to 1571
570 extra day-case admissions are attributable to demand
But overall secondary care spend similar to top quintile.

11. Haematological cancer
Activity
Inpatients
2013/14
2014/15
2015/16 (FOT)
% change
Inpatient
Plymouth Hospitals NHS Trust 52 74 62
20.00%
Royal Devon & Exeter
145
144
130
-10.62%
Northern Devon NHS Trust 38 29 24
-36.84%
Daycase
828
1161
1200
44.93%
4897
4980
5042
2.97%
648
685
547
-15.56%
Outpatients
5525
5855
6007
15.38%
3034
2023
3348
43.72%
3285
3155
3175
7.22%
Outpatient to daycase ratio
6.67
5.04
5.01
0.62
0.41
0.66
5.07
4.61
5.80
Trend is showing a shift away from elective inpatients to day-case / outpatients
RD&E has high level of outpatients compared to PHNT/ NDHT.

12. Summary of potential gains
Theme
Where
Gain
When
Note
Skin
Prevention
Daycase
1021
Long-term
High incidence
Acute
1054
Short-term
Daycase to outpatient procedure?
410
N/A
Contract adjustment included
Urological 92
218
Haematological
570
1571
Overall gain in secondary care may be less